Laura A. Huppert, M.D., breast physician and assistant professor of medicine at the University of California, San Francisco, discusses important data that inform the optimal sequence of immunotherapy, PARP inhibitors, and conventional chemotherapy regimens in treating early-stage patients. Triple negative breast cancer (TNBC).
The need for adjuvant pembrolizumab (Keytruda) in patients with early-stage TNBC who achieve a pathological complete response (pCR) after neoadjuvant therapy remains uncertain, Dr. Huppert begins.
Currently, Huppert continued, the standard of care is to continue treatment with pembrolizumab based on the phase 3 KEYNOTE-522 trial (NCT03036488), which tested neoadjuvant pembrolizumab and chemotherapy in early-stage disease, followed by chemotherapy. demonstrated the benefit of adjuvant pembrolizumab. However, she notes that the need for pembrolizumab as adjuvant therapy may be reevaluated based on data from ongoing trials.
Therefore, ongoing studies such as the phase 3 OptimICE-PCR trial (NCT05812807) aim to address this issue, she said. In this trial, we randomly assigned patients who achieved pCR after administration of neoadjuvant pembrolizumab to either continue pembrolizumab for 1 year or undergo observation, and evaluated the effectiveness of adjuvant pembrolizumab in this setting. Provides valuable data about the role.
About data from interim analysis of the Phase 3 IMpassion030 trial (NCT03498716) evaluating the addition of adjuvant-only atezolizumab (Tecentriq) to standard chemotherapy in stage II or III patients who underwent surgery prior to immunotherapy Dr. Huppert describes this in detail. Findings suggested no additional benefit in invasive disease-free survival compared with chemotherapy alone. This highlights the importance of preoperative immunotherapy in optimizing outcomes for patients with stage II or III disease, Huppert explains.
Huppert added that it is important to optimally stage patients to ensure they receive appropriate neoadjuvant therapy. If patients initially undergo surgery, the IMpassion030 data suggest that adding adjuvant immunotherapy based on this approach alone may not provide additional benefit. Therefore, Huppert concludes that treatment decisions must be made individually based on each patient’s specific clinical scenario and available data.
